Preventive fixation of the greater trochanter in the intramedullary nail for unstable pertrochanteric fractures of the femur: Xander's technique.

Abstract

Introduction: Proximal femoral fractures (PFF) represent a global public health burden as more than 10 million cases per year are globally reported. Kyle 3 and 4 or AO/OTA 31.A2 pertrochanteric fractures account for 10-15% of all PFF. This specific fracture pattern is characterized by intrinsic mechanical instability as a result of the presence of a detached greater trochanter fragment and is usually treated using a cephalomedulary nail (CMN). However, the unstable greater trochanter fragment makes the insertion of the CMN guide wire challenging.

Hypothesis: The aim of this surgical technical note is to describe this procedure basically allowing fracture simplification from unstable to stable, so that this complex PFF pattern can be approached in a structured manner with predictable results in terms of fracture reduction quality and implant position accuracy, even by junior surgeons.

Material and methods: We used this greater trochanter stabilization technique in 34 pertrochanteric fracture fixations with a CMN. Fracture union was achieved in all cases by a minimum one-year follow-up period without surgical complications.

Discussion: The authors developped a surgical technique allowing for both stable greater trochanter fragment stabilization and easier CMN guide wire insertion to avoid fracture dislocation and fragment collapse.

Level of evidence: II.